tbuckley/cabot-search huggingface dataset:
Abstract 15848: Prognostic Value of Left Ventricular Diastolic Function in Patients With Hypertrophic Cardiomyopathy
Authors: Cifci Gizem, Songnan Wen, Ahmad Abdelrazek, Khaled Ali, Sorin V Pislaru, Patricia A Pellikka, Garvan C Kane, Jeffrey B Geske, Cristina Pislaru
Journal: Circulation (2022)

Background: Diastolic dysfunction (DD) is frequently present in patients with hypertrophic cardiomyopathy (HCM) due to abnormal left ventricular (LV) relaxation, wall hypertrophy, increased LV filling pressures and myocardial disarray and fibrosis, even though ejection fraction (EF) remains preserved until late stages. Our aim was to investigate in a large cohort whether contemporary markers of DD and increased filling pressures are associated with outcomes in these patients. Methods: We screened consecutive patients with HCM who had transthoracic echocardiography and no significant valvular heart disease. The associations of septal/lateral e’ velocity, E/e’, left atrial volume index (LAVi), and tricuspid regurgitant velocity (TR) with all-cause mortality were tested. A diastolic score (DS) was also calculated (1 point for each abnormality in e’, E/e’, TR, LAVi). Results: 1,496 patients with HCM were studied (mean age 52±15 yrs; 61% men; LV EF 69±7%; Table). Diastolic abnormalities were highly prevalent in these patients ( Table ). In the subset without septal reduction therapy (SRT; n=900), at a median followup of 9 years (IQR 7-11 yrs; n=78 deaths), increased E/e’ and DS were strongly associated with mortality (log-rank P &lt;.0001 for both; Figure ). However, E/e’ did not remain significant in multivariable models after adjustment for known cardiac risk factors or other significant confounders ( Table ). In contrast, DS &gt;2 remained independently associated with ~2-fold higher mortality risk (adjusted HR 1.91 [1.14-3.20, P =.01]; n=693; Table). In patients who underwent SRT (n=596), these associations showed the same trend but attenuated. Conclusion: In HCM patients who did not require SRT, the severity of DD was associated with mortality, independent of cardiac pump function or known cardiac risk factors. The composite score was more powerful than E/e’. Further studies are needed to fully understand the impact of DD in these patients with and without SRT.
Abstract 262: Race/ethnicity Is Associated With Mortality After Pediatric Cardiopulmonary Resuscitation: An Analysis Of The KIDs’ Inpatient Database
Authors: Amanda Ohalloran, Garrett Keim, Cody Gathers, Jessica Fowler, Maryam Naim, Joseph Rossano, Robert A Berg, Robert M Sutton, Nadir Yehya, Ryan Morgan
Journal: Circulation (2022)

Introduction: Survival disparities in adult in-hospital cardiac arrest (IHCA) are well-described with decreased survival in Black patients. Pediatric literature from AHA’s GWTG—Resuscitation did not show this association, possibly due to differences in IHCA definitions and patient population. We aimed to investigate associations between outcomes after pediatric CPR and race/ethnicity and insurance payer status in a nationally representative database. We hypothesized non-White race/ethnicity, compared to white race, and public insurance, compared to private insurance, would be associated with lower rates of survival. Methods: Retrospective cohort study of subjects ≤18 years with CPR procedure codes in the 1997- 2019 editions of the Healthcare Cost and Utilization Project Kids’ Inpatient Database (KID). We excluded subjects missing race/ethnicity, insurance payer or disposition and subjects with in-patient transfer as their disposition. We evaluated hypothesized associations with weighted mixed-effect logistic regression clustered by hospital. Hospital (size, teaching/non-teaching institution, rural/urban, region) and patient (age, KID cohort year, sex, insurance payer, complex chronic condition, median income quartile) confounders were considered fixed effects. Individual hospitals were treated as a random effect. Results: Our cohort included 27,332 children admitted to 3,353 centers. Univariable and multivariable modeling showed higher odds of in-hospital mortality for all non-White categories compared to white race: Black (aOR 1.20, 95% CI 1.08-1.34; p&lt;0.001), Hispanic (aOR 1.17, 95%CI 1.05-1.31; p=0.006), and other race/ethnicity (aOR 1.37, 95%CI 1.20-1.57; p&lt;0.001). There was no difference in mortality between those with public and private insurance. Conclusions: In contrast to previously published data, after risk- and reliability-adjustment of individual and hospital-level effects, children receiving CPR with non-White race/ethnicity had higher mortality odds. These findings suggest the presence of race/ethnicity-based disparities in pediatric IHCA mortality, the mechanisms of which should be explored.
Abstract 266: Impact Of Bystander-patient Relationship On Neurological Outcome In Witnessed Elderly Patients With Out-of-hospital Cardiac Arrest According To Age: A Nationwide Population-based Observational Study
Authors: Akira Funada, Yoshikazu Goto, Masayuki Takamura
Journal: Circulation (2022)

Introduction: Elderly patients with out-of-hospital cardiac arrest (OHCA) witnessed by a family member were associated with worse neurological outcome than those witnessed by a non-family bystander. Hypothesis: Impact of bystander-patient relationship (family member or non-family bystander) on neurological outcome in witnessed elderly OHCA patients could differ based on age. Methods: We evaluated 13,773 bystander-witnessed elderly OHCA patients (age ≥ 65 years) of cardiac origin who achieved prehospital return of spontaneous circulation (ROSC). Data were obtained from the prospectively recorded All-Japan Utstein-style Registry between 2011 and 2016. The primary outcome was 1-month neurologically intact survival, defined as a cerebral performance category (CPC) score of 1 or 2. Patients were divided into three groups by age (65-74, 75-89, and ≥ 90 years). Results: The rates of 1-month CPC 1-2 and the frequencies of bystander-initiated cardiopulmonary resuscitation (BCPR) were significantly higher in patients witnessed by a non-family bystander [27.4% (1,360/4,971) and 68.5% (3,407/4,971)] than in those witnessed by a family member [19.7% (1,736/8,802) and 44.8% (3,942/8,802)] (p &lt; 0.001, respectively). The rates of 1-month CPC 1-2 in patients aged 65-74, 75-89, and ≥ 90 years decreased with advancing age, 36.2% (1,733/4,788), 16.9% (1,264/7,469), and 6.5% (99/1,516), respectively (p for trend &lt; 0.001). The rates of 1-month CPC 1-2 were significantly higher in patients witnessed by a non-family bystander than in those witnessed by a family member in those aged 65-74 years (45.0% and 30.9%) and 75-89 years (20.2% and 15.3%) (p &lt; 0.001, respectively), but not in those aged ≥ 90 years (6.4% and 6.7%, p = 0.83). In multivariate logistic regression analysis adjusted for sex, initial rhythm, and time from call receipt to ROSC, witness by a non-family bystander and BCPR were significantly associated with 1-month CPC 1-2 for patients aged 65-74 years (adjusted odds ratio: 1.37 and 1.44, respectively; 95% confidence interval: 1.19-1.58 and 1.26-1.66, respectively), but not in those aged 75-89 and ≥ 90 years. Conclusions: Impact of bystander-patient relationship on neurological outcome in witnessed elderly OHCA patients varied with age.
Abstract 15650: Relationship Between Lipoprotein (a) and Aortic Vulnerable Plaques Detected by Non-Obstructive General Angioscopy
Authors: Keisuke Kojima, Yutaka Koyama, Yasunari Ebuchi, Nobuhiro Murata, Yasuo Okumura
Journal: Circulation (2022)

Background: Although atherosclerotic disease including myocardial infarction had decreased with lipid-lowering therapy for LDL cholesterol, atherosclerotic risk factors as residual risks without low-density lipoprotein are pointed out. Especially, lipoprotein (a) had been reported as one of the cardiovascular risks. Non-obstructive general angioscopy (NOGA) can meticulously visualize directly aortic atherosclerosis. NOGA-derived aortic vulnerable plaques had been reported to be related to future cardiovascular events. However, the relationships between serum lipoprotein (a) value and NOGA-derived aortic plaques had not been fully investigated yet. Methods and Results: We investigated consecutive 165 cases with coronary artery disease evaluated for the aorta by NOGA. Atherosclerotic lesions of the aorta were screened using NOGA immediately after coronary arteriography. NOGA examination evaluated the presence of aortic ruptured plaques which were "puff-chandelier rupture" appearance as previously reported. The mean age was 68 years and the median lipoprotein (a) value was 16 [9-27]. The median number of plaque ruptures was 1 [0-3], and 60% of cases had at least one plaque rupture. In a logistic regression analysis for the presence of aortic plaque rupture, the serum lipoprotein (a) value was associated with NOGA-derived aortic plaque rupture (odds ratio, 1.01 [1.0-1.03], p &lt; 0.05). The study patients were divided into three groups according to the tertile of serum lipoprotein (a) value [1st tertile: 0-11 mg/dl, 2nd tertile: 12-24 mg/dl, 3rd tertile 25 mg/dl &lt;], the first tertile had the lowest prevalence of plaque rupture (the presence of plaque rupture: first tertile 50%, second tertile 71%, third tertile 72%, p = 0.03). Conclusion: Serum lipoprotein (a) value was related to the presence of the aortic plaque rupture. Further studies are needed to elucidate the effect of the low lipoprotein (a) on the prevention of aortic vulnerable plaques.
Abstract 249: Impact Of Partial Pressure Of Carbon Dioxide On Survival And Neurologic Outcomes In In-hospital Cardiac Arrest Patients
Authors: Jignesh K Patel, Natalie Millet, Yevgeniy Genchanok
Journal: Circulation (2022)

Background: As cardiac arrest remains an event associated with high morbidity and mortality, interventions to mitigate neurologic injury and improve survival in these patients is an area of ongoing research. As carbon dioxide levels play an important role in cerebral vascular regulation, targeting a specific partial pressure of carbon dioxide (PaCo2) is a potential therapeutic intervention in cardiac arrest care. Our study aims to determine the impact of PaCo2 on survival and neurologic outcomes in in-hospital cardiac arrest (IHCA) patients. Methods: This study is a single center prospective observational study. The population included IHCA patients from August 2011 to July 2021. Arterial blood gas data (ABG) was available for 154 patients intra cardiac arrest and 336 patients in the post ROSC period. PaCo2 levels from the ABG data where subdivided into different ranges including hypocapnia (PaCo2 &lt;35mm Hg), normocapnia (35-45 mm Hg) and hypercapnia (&gt;45mmHg). The primary outcomes of interest were survival to hospital discharge and neurologic outcome. Results: Analysis of the PaCo2 data demonstrated that intra arrest PaCo2 was not associated with survival to discharge (p value 0.129). Mild hypercapnia (PaCO2 46-54 mmHg) and moderate hypercapnia (55-79mmHg) intra arrest were associated with favorable neurologic outcomes (p value 0.039). A univariate analysis of post ROSC ABG data demonstrated that normocapnia was associated with survival to discharge (p value &lt;0.001) and favorable neurologic outcomes (p value 0.05). Similar findings were seen in two multivariate analyses examining the association of PaCo2 with survival and neurologic outcome. The multivariate analysis examining survival showed that hypocapnia and hypercapnia were associated with a higher mortality compared to normocapnia (p values 0.016 and &lt;0.001). In the multivariate analysis examining neurologic outcomes, hypercapnia was associated with worse neurologic outcome when compared to normocapnia (p value 0.004). Conclusions: Post ROSC, normocapnia was associated with favorable neurologic outcomes and survival to discharge. Our study supports targeting normocapnia in the post cardiac arrest period.
Abstract 15598: Sexual Dimorphism in Hospital Outcomes Among COVID-19 Hospitalizations
Authors: Sandeep Appunni, Venkataraghavan Ramamoorthy, Md Ashfaq Ahmed, Zhenwei Zhang, Peter McGranaghan, Ramez Morcos, Joseph Salami, Muni Rubens, Anshul Saxena, Emir Veledar, Javier Jimenez, Sandra Chaparro
Journal: Circulation (2022)

Introduction: According to recent global estimates there are nearly 530 million cases and 6.3 million deaths due to novel coronavirus disease 2019 (COVID-19) pandemic. Studies have shown that COVID-19 disproportionately affects males than females. In this study we looked at differences in in-hospital outcomes of COVID-19 based on sex using a larger administrative database. Hypothesis: The adverse in-hospital outcomes of COVID-19 will be significantly higher among males. Methods: This was a retrospective analysis of the California State Inpatient Database 2020. All COVID-19 hospitalizations with age 18 years and above were included for the analysis. These hospitalizations were classified into males and females. The main outcomes of the study were in-hospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and ICU admission. Any length of stay ≥75th percentile value for the entire cohort was considered as prolonged length of stay. Logistic regression analyses after adjusting for covariates were used to compare COVID-19 related outcomes between males and females. Results: A total of 95,180 primary COVID-19 hospitalizations were included for the analysis. Of these 52465 (55.1%) were males and 42715 (44.9%) were females. Among these hospitalizations, mortality (12.4% versus 10.1%, P&lt;0.001), prolonged length of stay (30.6% versus 25.8%, P&lt;0.001), vasopressor use (2.6% versus 1.6%, P&lt;0.001), mechanical ventilation (11.8% versus 8.0%, P&lt;0.001), and ICU admission (11.4% versus 7.8%, P&lt;0.001) were significantly higher among males. Logistics regression analysis showed that males had significantly greater odds for mortality (aOR, 1.38, 95% CI: 1.32-1.44), prolonged length of stay (aOR, 1.35, 95% CI: 1.31-1.39), vasopressor use (aOR, 1.59, 95% CI: 1.51-1.66), mechanical ventilation (aOR, 1.62, 95% CI: 1.47-1.78), and ICU admission (aOR, 1.58, 95% CI: 1.51-1.66). Conclusions: Adverse outcomes such as mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and ICU admission were independently associated with male sex. These findings could be due differences to both biological and social factors between the sexes. Future studies should explore these factors to efficiently control COVID-19.
Abstract 15498: Treatment Adherence in Patients With Non-st Elevation Acute Coronary Syndrome
Authors: Lucia Victoria Campos Cervera, Juan P Costabel, Marcos Viruel, Florencia Muñoz, EZEQUIEL ZAIDEL, Rosina Arbucci, Gonzalo Perez, JosÃ© Bonorino
Journal: Circulation (2022)

Introduction: Optimal medical treatment demonstrated a reduction in cardiovascular outcomes after acute coronary syndrome. Treatment adherence results crucial to obtain that benefit, we do not have current data on the adherence in our population. Our objective was to evaluate the treatment adherence at 6 and 15 months in patients post non-ST elevation acute coronary syndrome (NST-ACS). Methods: It’s a prespecified sub-analysis in the prospective registry BUENOS AIRES 1 that include 1100 patients. The adherence was evaluated using the modified Morisky-Green scale. Results: The mean age was 65 ±11 years. At 6 month 76.4% were consider as adherents to pharmacological treatment. We didn’t find any predictors for adherence. Adherent patients had a rate of combined isquemic events (myocardial infarction, death or stroke) of 11.5% (52/452) versus 20% (27/135) in non-adherent patients at 15 months. Treatment adherence was an independent predictor of combined isquemic events (HR 0.517, IC95% 0.308-0.869, p=0.013). There weren’t any differences in the hemorrhagic events between the two groups. Conclusions: Our population had a high adherence treatment without any clinical predictor of this phenomenon. Adherence was related to a reduction in isquemic events without changing the hemorrhagic events. Nonetheless, one of four patients was considered as non-adherent after a hospitalization for NST-ACS, showing that we need intervention to reduce this number.
Abstract 212: The Effect Of 33 °C Vs. 36 °C Targeted Temperature Management To The Metabolism Following Out-of-hospital Cardiac Arrest.
Authors: Rasmus Paulin P Beske, Laust E Obling, Jesper Kjaergaard, Niklas Nielsen, John Bro-Jeppesen, Pär I Johansson, Christian Hassager
Journal: Circulation (2022)

Targeted Temperature Management (TTM) following shockable out-of-hospital cardiac arrest (OHCA) has been recommended. The effect of different targeted temperatures on the human metabolome has not been compared. Elevated levels of metabolites from the Krebs cycle have recently been associated with a poor outcome in OHCA patients. Similarly, decreased levels of the amino acids valine and leucine have been linked with a poor outcome in septic shock patients. Method: From a single center in the randomized clinical TTM trial, we analyzed blood samples from resuscitated unconscious OHCA patients at two timepoints (hospital arrival and 48 hours later) using ultra-performance liquid mass-spectrometry. Patients were randomized to either 33°C or 36°C hypothermia for the first 28 hours. Sixty-one metabolites of the ~3000 compounds detected were prespecified for quantification and analyzed in the current study. Differences (95% CI) in metabolite concentrations from a constrained linear mixed model are reported, and p-values from the interaction term timepoint x TTM arm. Results: Of the 146 patients, 70 (48 %) were randomized to TTM 33°C. The baseline characteristics (age, gender, shockable rhythm, time to return of spontaneous circulation) and outcome (180 days mortality) were similar in the TTM groups. After 48 hours, approx. 24 hours from the cessation of TTM, fourteen metabolites differed significantly between the two groups. Among these, lactate acid (190 μM (74-305 μM), p&lt;0.001 ), pyruvic acid (26 μM (8-44 μM), p&lt;0. 0 1 ), 2-oxoglutaric acid (2.7 μM (1.0-4.4 μM), p&lt;0.01 ) and prostaglandin E2 (0.60 nM (0.24-1.0 nM), p&lt;0.01 ) were increased in the TTM 33 °C arm whereas valine (25 μM (15-35 μM), p&lt;0.001 ) and leucine (14 μM (8.3 - 20 μM), p&lt;0.001 ) were decreased. Conclusion: TTM at 33°C for 24 hours after OHCA results in a prognostically poorer metabolome even 24 hours later compared with TTM at 36°C.
Abstract 15589: Evaluating Methods to Mitigate the Bias for Machine Learning-Based Cardiovascular Risk Model
Authors: Fuchen Li, Juan Zhao, Patrick Wu, Henry H Ong, Wei-qi Wei, Josh F Peterson
Journal: Circulation (2022)

Introduction: Cardiovascular disease (CVD) is the leading cause of death in the U.S. and globally. Predictive models are essential for identifying high CVD-risk patients. Machine learning (ML) models have been used to develop predictive models. However, the dataset generalized for training ML models could involve a systematic bias (e.g., sampling bias), which could bias the model. The study investigated the performance of different methods to reduce bias for 10-year CVD prediction models among demographic groups (White and Black, Male and Female). Methods: We used a large cohort derived from VUMC de-identified EHR data, including outpatients with follow-up visits between 2007 and 2017. Logistic regression (LR), random forests (RF), and gradient boosting trees (GBT) were trained. Predictors included traditional CVD risk factors, labs, prior diagnosis, and medications. Fairness metrics were equal opportunity difference (EOD) - a difference of true positive rate (0 indicates fairness), and disparate impact (DI) - a ratio of predicted CVD (1 indicates fairness) among groups. Three de-biasing methods were applied, removing protected attributes (i.e., race, gender) from the model, resampling the training set by sample size, and by the proportion of CVD. Results: The study included 109, 490 individuals (9,824 CVDs) with mean (SD) age of 47.4 (14.7) years (White 86.3%, Black 13.7%, Male 35.5% and Female 64.5%). Models had a slight bias across race groups but a large EOD and DI across genders (i.e. models has higher prediction accuracy in Male than Female). After debiasing, EOD and DI were significantly improved for genders (Fig. 1). Resampling by size reduced bias while retaining accuracy (e.g. 0.78 AUROC for GBT). Conclusions: Among the VUMC cohort, despite the high proportion of women, ML models had a lower prediction accuracy for the women group. Resampling the training set data reduced the bias, but it should be used with caution depending on the magnitude and nature of the bias.
Abstract 15742: Thoracic Aortic Aneurysmal Disease Prevalence and Outcomes in Women With Connective Tissue Diseases
Authors: Afsheen Nasir, Mohammad Zafar, Asanish Kalyanasundaram, Alexandra Sonsino, Dimitra Papanikolaou, Maryam Tanweer, Yupeng Li, Bulat A Ziganshin, robert elder, katherine campbell, Lawrence S Cohen, John A Elefteriades, Josephine Chou
Journal: Circulation (2022)

Introduction: Connective tissue disease patients are at risk for thoracic aortic aneurysm (TAA) and its complications. We sought to clarify risk factors for TAA specific to women. Methods: Using Yale Aortic Institute database, we identified 266 female patients with diagnosis of Marfan’s, Ehlers-Danlos, or Loeys-Dietz Syndromes. We included imaging, clinical and surgical information collected using retrospective chart review. Results: Amongst women with CTD, the prevalence of TAA in our population was 25%. MFS patients constituted 23% of the study population but accounted for 70% of aneurysm patients. EDS patients comprised 74% of the study population and 24% aneurysm patients. LDS comprised a small percentage of both populations. Non-Caucasian ethnicities seemed to have much higher likelihood of developing an aneurysm. CTD patients with aortic aneurysms were more likely to have valvular heart disease (VHD: MVP, AI), HTN, DLP, and DM. Aneurysm rates were slightly higher in ever-pregnant patients, with highest rates in MFS. TAA patients had higher rates of all-cause mortality (15% vs 2%). CV/aortic-related complications and death occurred only in TAA patients. Aortic dissection occurred in 24%; 30/67 required aortic surgery, with 13/67 requiring multiple surgeries. MFS manifested higher rates of aortic dissection (40%), surgery (40%), and mortality (both all cause and CV/Ao). Conclusions: TAA is common amongst women with CTD, with Marfan’s patients being at highest risk for TAA and its complications (aortic dissection, need for surgery, and death). Risk factors for TAA were VHD, HTN, DLP, and DM. Pregnancy appears to be a risk factor for TAA in select CTD subgroups.
Successful removal of a migrated biliary plastic stent using a novel spiral dilator
Authors: Yusuke Ishida, Takehiko Koga, Naoaki Tsuchiya, Kaori Hata, Kei Nishioka, Noriko Shiga, Fumihito Hirai
Journal: Endoscopy (2023)

Endoscopic plastic stenting is an established biliary drainage technique. However, plastic stents may migrate proximally or distally, causing recurrent biliary obstruction [1]. The Tornus ES (Olympus Co., Tokyo, Japan) is a newly designed coil-sheath dilator with a screw-shaped tapered tip ([Fig. 1]) that has been recently reported in endoscopic interventions [2] [3] [4] [5]. We herein introduce successful troubleshooting using this novel spiral dilator for removal of a migrated biliary plastic stent.
Effective endoscopic treatment of intrahepatic stones after Roux-en-Y hepaticojejunostomy: a pediatric case
Authors: Koichi Soga, Shun Takakura, Junki Yumoto
Journal: Endoscopy (2023)

An 11-year-old Japanese boy presented to our hospital with intrahepatic biliary duct stones and regional cholangitis. He had undergone cholecystectomy, complete excision of the extrahepatic biliary duct, and Roux-en-Y hepaticojejunostomy for choledochal cysts (Todani classification IVa) at the age of 8 years. Abdominal magnetic resonance imaging confirmed cystic dilatation of the left hepatic duct and the presence of left intrahepatic biliary duct stones ([Fig. 1 a]).